ObjectiveTo evaluate the efficacy of modified ultrafiltration (MUF) combined with conventional ultrafiltration (CUF) for cardiac valve replacement in patients with severe valve disease.MethodsOne hundred and eight NYHA Ⅲ or Ⅳ patients with severe valve disease,aged≥ 18 yr,weighing 50-80 kg,scheduled for elective cardiac valve replacement under cardiopulmonary bypass (CPB) were randomized into CUF group ( n =56) and CUF combined with MUF group (CMUF group,n =52).MUF was performed at the end of CPB,and the flow and time was 400 ml/min and 15-20 min respectively.Arterial blood samples were taken for blood gas analysis and for measurement of the plasma IL-6 and IL-8 concentrations after induction of anesthesia (T1),at the beginning of CUF (T2),at the end of GUF (T3),at the beginning of MUF (T4),at the end of MUF (T5),and at 2,8 and 24 h after the termination of CPB (T5-8).The oxygenation index was calculated and the airway pressure was recorded at T5 8.The amount of urine output during operation,the amount of urine output and volume of chest tube drainage within 24 h after operation,extubation time,packed red blood cell (PRBC) transfusion and duration of stay in ICU were recorded.ResultsCompared with CUF group,the hematocrit at T5,6 and oxygenation index at T7,8 were significantly increased,extuhation time was significantly shortened,and the amount of urine output and volume of chest tube drainage within 24 h after operation and PRBC transfusion were significantly reduced ( P ＜0.05),and no significant change was found in the plasma IL-6 and IL-8 concentrations,airway pressurc,amount of urine output during operation,and the duration of stay in ICU in group CMUF ( P ＞ 0.05).ConclusionCombination of MUF and CUF during CPB can be used for cardiac valve replacement in patients with severe valve disease,improve the function of organs after operation and reduce homologous blood transfusion.

ObjectiveTo investigate relationship between the degree of placenta praevia, vaginal bleeding and clinical outcomes. MethodsRecords of 89 patients with placenta praevia(mild praevia group 43; severe praevia group 46) were reviewed retrospectively, and outcomes were compared. ResultsThe gestational age at the first bleeding and diagnosis was significantly smaller in severe group than that in mild one (P<0.05). The incidence of antepartum haemorrhage, the times of bleeding and the episodes of heavy bleeding in two groups showed no significant differences(P>0.05). The gestational age at diagnosis and delivery and birthweight were significantly smaller in women with antepartum bleeding than in those without( P<0.01 ). The number of deliveries by emergency caesarean section in women with antepartum bleeding was significantly higher than that in those without (P<0.01). ConclusionThe clinical outcomes of placenta praevia are highly variable. There are no obvious clinical features that are typical in predicting the clinical outcomes. The number of bleeding episodes and the degree of praevia are not associated with outcomes, so they can't be the proof to determine the treatment plan ahead of time.

Objectives To study the effect of preoperative platelet transfusion for splenectomy and devascularization in the prevention of intraoperative and postoperative bleeding.Methods The 230 patients with cirrhosis and portal hypertension who received splenectomy and periesophagogastric davascularization were divided into strata A,B and C according to the platelet counts.Stratum A patients had a platelet count of less than 30× 10/L,B between 30× 10/L and 50× 109/L,and C more than 50 × 109/L.The patients in each stratum were then randomly divided into a preoperative transfusion group (T group) and a non-transfusion group (NT group).The amounts of intraoperative bleeding,postoperative drainage in 48 hours after operation,rates of postoperative bleeding,and general medical conditions were compared.Results A comparison in stratum A showed lower amounts of intraoperative bleeding and 48 hour postoperative drainage,and a lower rate of bleeding in the T group (P＜0.05).There were no significant differences between the T and the NT groups in strata B and C (P＞0.05).Conclusions For patients with a platelet count lower than 30 × 109/L,preoperative platelet transfusion significantly reduced bleeding suggesting that preoperative platelet transfusion for splenectomy and periesophagogastric devascularization should be a routine.For those patients whose platelet count was above 30 × 109/L,platelet transfusion is not recommended.

Objective To evaluate two kinds of anterior screw fixations in the treatment of odontoid fractures. Methods A total of 36 patients with D' Alonzo type Ⅱ odontoid process fractures were treated with anterior screw fixation in our department from 1999 to July 2009. There were 28 males and 8 females at mean age of 42.3 years (rang 17-59 years). According to time and surgery procedures, the patients were divided into Group A ( from 1999 to June 2005, n = 11 ) and Group B ( from June 2005 to July 2009, n = 25 ). Patients in Group A received anterior hollow screw fixation of the odontoid process monitored under G-arm or C-arm, while those in Group B received anterior screw fixation of the odontoid process assisted by Iso-C 3D navigation system. The operation time and blood loss in two groups were compared by Student' s t test and analyzed with SPSS 13.0 statistical software. X-ray examination was performed in all patients 3, 6 and 12 months after operation to observe fracture union and stability of the upper cervical spine. Results The operation time was ( 102 ± 12) min ( range, 77-148 min) in Group A and ( 104 ± 14) min ( range, 71-150 min) in Group B, with no statistical difference ( P =0.21 ). The blood loss was (465 ± 5) ml (range, 20-130 ml) in Group A and (42 ± 6) ml (range, 26-150 ml) inGroup B, with no statistical difference (P = 0.16). All patients received reexamination three months after operation, which showed no bony union or dislocation but average 40% restriction of neck rotation. One year after operation, 30 patients (83%) got fracture union and six ( 17% ) got fiber healing, with average 24% restriction of neck rotation. Conclusions There is no statistical significant differences between two groups in aspects of operation time, blood loss and fracture healing. But anterior screw fixation of the odontoid process assisted by Iso-C 3D navigation system can reduce exposure to radiation of both patients and surgeons. Furthermore, solid screws can be applied to augment the fixation intensity and thereby reduce the complications caused by non - union.

Objective NAC therapy was used to observe the effect of TNF-?,hs-CRP,PaO2,PaCO2and lung function in patients with COPD,so as to evaluate the therapeutic effect. Methods 65 patients with COPD were recruited and the patients were randomly divided into 2 treatment groups:control group (n=31) and experimental group (n=34). Patients in the two groups received the conventional treatment of COPD in unchanged dosage for the duration of the study except stopping using antibotic drug after infection was resolved. NAC tablets were taken orally at a dose of 600mg once a day in experimental group. After 8 weeks treatment,we appraised lung function and the plasma level of TNF-?,hs-CRP,PaO2 and PaCO2. Results Compared with normal controls,the plasma levels of TNF-? and hs-CRP increased significantly. The higher level of those ,the higher lung function class was in 65 COPD patients,and there was significant effect(P

With the continuous improvement of people's living standard, more and more people are in pre-diabetes state. Pre-diabetes is the key to the development of diabetes, and early intervention can reduce the incidence of diabetes, and prevent transforming pre-diabetes to diabetes in order to maintain the health status of the patient. By retrieving the Chinese Biomedical Literature Database of nearly five years on pre-diabetes intervention literature, it was found that traditional Chinese medicine interventions in pre-diabetes have a relatively new understanding. Through the traditional Chinese medicine, acupuncture, acupoint massage, and combine traditional Chinese and western medicine, medicinal food, eight brocade etc intervention therapy in patients with pre-diabetes, the occurrence and development of diabetes and its complications can be effectively prevented.

Objective: To evaluate the correlative risk factor of culprit lesion plaque composition in patients with acute coronary syndrome (ACS).
Methods: A total of 55 ACS patients with 55 culprit vessels were divided into 2 groups:Unstable angina group, n=40 and AMI group, n=15. Coronary angiography (CAG) was conducted in all patients, the minimal lumen area and plaque burden at the minimal lumen area and the largest necrotic core were examined. Intravascular ultrasound with virtual histology (IVUS-VH) were performed to calculate the percentages of necrotic core area (NC%), dense calcium (DC%), ifbro-fatty area (FF%), ifbrous area (FI%) and to calculate the remodeling index. Plasma levels of matrix metalloproteinase-9 (MMP-9), oxidative low density lipoprotein (Ox-LDL) and hypersensitive c-reactive protein (hs-CRP) were also compared between 2 groups.
Results: In AMI group and UAP group, NC%at minimal lumen area were (27.90 ± 9.72)%and (19.41 ± 11.53)%, t=-2.533, P=0.014;NC%at the largest necrotic core were (39.09 ± 8.82)%and (31.99 ±1 2.35)%, t=-2.032, P=0.047;plasma levels of MMP-9 were (14.63±2.71) μg/L and (12.65±2.72) μg/L, t=-2.411, P=0.019;Ox-LDL were (196.21±25.89) μg/L and (159.57±33.39) μg/L, t=-3.832, P=0.001;hs-CRP were (1.57±1.93) mg/L and (0.31±0.33) mg/L, t=-2.514, P=0.024 respectively. Plaque composition was not related to plasma levels of MMP-9, Ox-LDL and hs-CRP. In the largest necrotic core of cruprit lesion and the minimal lumen area, MLA were (5.25±2.15) mm2 and (3.45±1.07) mm2, t=-6.348, P=0.001;NC%were (33.93±11.85)%and (21.73±11.62)%, t=-8.752, P=0.001 respectively.
Conclusion: ①Among ACS patients, AMI patients had the larger necrotic core area at cruprit lesion and higher MMP-9, Ox-LDL and hs-CRP.②There was no largest necrotic core composition at the minimal lumen area in the same cruprit lesion.③Plaque composition was not related to MMP-9, Ox-LDL and hs-CRP.

Objective To explore the mechanism of preventive effect of Chinese medicine with Replenishing kidney and invigorating Qi on osteoarthritis. Methods 72 male Long-eared white rabbits aged 4 months were randomly divided into six groups, A group (blank control group), B group (model group), C group (traditional Chinese medicine high-dose prevention group), D group (Chinese herbal medicine with medium-dose prevention group), E group (Chinese herbal medicine with low-dose prevention group), F group (glucose-amino acid hydrochloride capsules prevention group).All the animals apart from A group were established osteoarthritis model by immobilizing knee joint with plaster cast for 6 weeks. In the same time of immobilization, traditional Chinese medicine and glucose-amino acid hydrochloride capsules were given to C, D, E and F group for 4 weeks. Physiological saline was given to B group. After 6 weeks of modeling, synovial fluid was extracted and the changes of TNF-α in it were analyzed by ELISA. Results Articular cartilage degeneration of B group was most obviously compared with C, D, E and F group. There was a significant difference of TNF-α level in comparison of A and B group (P＜0.05), B and C, D, E and F group (P＜0.05), and among C, D and E group. Conclusion Chinese medicine with replenishing kidney and invigorating Qi can prevent osteoarthritis by reducing TNF-α level in synovial fluid, enhancing cartilage cell metabolism, and slowing down cartilage degradation.

Objective To explore the relationship between atherosclerotic plaque stability and junctional adhesion molecule A (JAM-A) in atherosclerotic mice.Methods Twenty-six apolipoprotein E gene knockout(ApoE-/-) mice were divided into three groups.Group A (six mice) was control group,group B (ten mice) was disposed by ligation and high-fat diet and group C was disposed by high-fat diet with ten mice.The formation process of plaques were observed with high resolution ultrasound(22 MHz),and plaque markers were detected to evaluate palque stability for secondary grouping (group D was vulnerable plaque group and group E was stable plaque group).The plaque stability were evaluated by plaque vulnerability index and the expression of JAM-A were analyzed using immunohistochemical staining.The relationship between atherosclerotic plaque stability and JAM-A in atherosclerotic mice were estimated with statistical methods at last.Results There was no plaque in carotid artery of group A.On the contrary,obvious plaques were observed in carotid artery of group B and C.The total serum lipids level in group A was normal.But high-fat diet could obviously decrease the serum HDL-cholesterol level of group B and group C when compared with the controls(P ＜0.05).High-fat diet could increase the ratio of non-HDL-cholesterol (TC,TG,LDL).As shown with pathological staining,the content of extracellular lipids and foam cells in the plaque were significantly increased vs.control (P ＜ 0.05).On the contrary,the content of smooth muscle cells and collagen fibers were significantly increased vs.control(P ＜0.05).The plaque vulnerability index of group D was higher than that in group E(P ＜0.01).The expression of JAMA was increased in group D and E,and in group D was higher(P ＜0.01).While,few JAM-A expression in group A.There was significant correlation between plaque vulnerability index and JAM-A (P＜0.01).Conclusions High resolution uhrasound(22 MHz) can observe the formation of carotid plaque in ApoE-/-mice.There was a positive correlation between JAM-A expression and the vulnerability of plaque in carotid artery.JAM-A might be used for evaluation of plaque stability as a new indicator.

Rheumatoid arthritis (RA), as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA.